Provider Demographics
NPI:1306980982
Name:ORTIZ, JOSEPH RALPH I (PHD, MFT)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RALPH
Last Name:ORTIZ
Suffix:I
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 GOLD CUP CT
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2767
Mailing Address - Country:US
Mailing Address - Phone:909-794-0973
Mailing Address - Fax:
Practice Address - Street 1:1573 GOLD CUP CT
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2767
Practice Address - Country:US
Practice Address - Phone:909-838-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 24073106H00000X
CAPSY 25127103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist